Request for Funds

Posted Wed, 02/23/2011 - 11:48 by toG_admin

Requesting Party

Organization: *

Contact Name: *

Email: *

Phone:

Address: *

City: *

State:

Zip: *

Funding

Amount Requested: *

Date Needed: *

Check Payable to: *

To whom do we write the check?

Purpose: *

Tell us what the money will be used for, who will benefit and why it is important.

Method of Payment:

Direct Payment to Vendor

Advance Payment to Organization or Individual

Reimbursement to Organization or Individual

Invoices or receipts will be required.

Certification: *

I declare under penalty of perjury under the laws of the State of Washington that the foregoing request for funds is true and correct and not made for any improper purpose.

Check this box to agree to these terms.

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Request for Funds